Keith F. Roberts Jr., MD
Individual provider Active NPI Surgery Physician · Demopolis, AL
NPI 1245320340 · NPPES record last updated Aug 27, 2013
Key facts
- NPI
- 1245320340
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 25746 (AL)
- Practice address
- 105 US Highway 80 E
Suite 215
Demopolis, AL 36732-3605 - Phone
- (334) 287-2840
- Fax
- (334) 287-2846
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- General Practice
- Education
- Meharry Medical College School of Medicine, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tombigbee Healthcare Authority
Practice addresses (Care Compare)
105 US Hwy 80 E
Demopolis, AL 36732-3605
Phone (334) 289-4000
Hospital & facility affiliations
- Southerncare New Beacon - Jasper
- Whitfield Regional Hospital
- DCH Regional Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 70 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060228000331 | AL | Practitioner - General Practice |
3476569419 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tombigbee Healthcare Authority | Current |
Accepting new patients | |
| Tombigbee Healthcare Authority | Current | Accepting new patients | |
| The Sylacauga Health Care Authority | Past | Accepting new patients | |
| Carraway Emergency Physicians, LLC | Past | Accepting new patients |
Locations
105 US Highway 80 E
Ste 215
Demopolis, AL 36732
Phone (334) 287-2825
105 US Highway 80 E
Ste 230
Demopolis, AL 36732
Phone (334) 287-2840
105 US Highway 80 E
Demopolis, AL 36732
Phone (334) 287-2669
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 25746 | AL | Yes |
Addresses
Primary practice location
105 US Highway 80 E
Suite 215
Demopolis, AL 36732-3605
Mailing address
PO Box 890
Demopolis, AL 36732-0890
Phone (334) 287-2840
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 166514001 | Medicaid | AR | |
| 150011 | Medicaid | AL | |
| 5H011 | Other | AR | BCBS |
| 51136881 | Other | AL | BLUE CROSS BLUE SHIELD |
NPI Registry JSON
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377561600000",
"number": "1245320340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 890",
"city": "DEMOPOLIS",
"state": "AL",
"postal_code": "367320890",
"telephone_number": "334-287-2840",
"fax_number": "334-287-2846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 US HIGHWAY 80 E",
"address_2": "SUITE 215",
"city": "DEMOPOLIS",
"state": "AL",
"postal_code": "367323605",
"telephone_number": "334-287-2840",
"fax_number": "334-287-2846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "KEITH",
"middle_name": "F.",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2013-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AL",
"license": "25746",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "166514001",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "150011",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "5H011",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "51136881",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Demopolis, AL
- Preferred Eye Care LLC
- R & O Inc
- R & O Inc.
- Renal Treatment Centers-Southeast LP
- RH Emergency Medicine of Whitfield LLC
- Ronnie T Chu MD P C
- Alvin Wayne Rowell
- Susan Flexer Roy
- RTG Medical
- Rural Health Medical Program, Inc
All providers in Demopolis, AL · Surgery Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.